FACT 40th Anniversary Champion Awards Nomination Form:
The Family and Children’s Trust (FACT) is seeking nominations for 4 FACT Champions to be recognized and celebrated for their exceptional impact in preventing family violence across the life span.  Professionals and community members are invited to complete the application below to nominate leaders who have made significant contributions in this space. Awards will be made to recognize champions who have made significant impact in protecting and strengthening individuals and families in each of the following 4 categories of family violence prevention: Children and/or Youth, Adults, Elders, and Families.
Please complete the following information below and return the completed application and all requested information by 11:59pm August 7th, 2026.
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Nominator Information:
Enter your information below.
Name
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Your relation/affiliation with the nominee:
*
Nominee Information:
All nominees must be individuals who work in Virginia (or have worked within the past 12 months) or who support Virginia serving organizations in the field of family violence prevention and treatment. You cannot nominate yourself.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Title/Role:
*
Award Category
*
Children & Youth
Adults (Domestic/Sexual Violence)
Older Adults
Families
Number of years involved in the field:
*
Number of years you have worked with this individual:
*
In what capacity do you know this individual? (ex. colleague, Board member, agency partner, etc.)
*
How long have you had a professional relationship with this individual?
*
Brief Description of the Nominee:
*
(Limit: 50 words)
0/50
Describe the Evidence of their Impact:
*
(Limit: 100 words)
0/100
Letters of Support from Community Members or Individuals Impacted by their Work - a minimum of two are requested
*
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Additional Attachments (Optional):
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Links:
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